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Autonomy Support of Nursing Home Residents With Dementia in Staff-Resident Interactions: Observations of Care. J Am Med Dir Assoc 2020; 21:1600-1608.e2. [PMID: 32553488 DOI: 10.1016/j.jamda.2020.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES People with dementia living in nursing homes benefit from a social environment that fully supports their autonomy. Yet, it is unknown to what extent this is supported in daily practice. This study aimed to explore to which extent autonomy is supported within staff-resident interactions. DESIGN An exploratory, cross-sectional study. SETTING AND PARTICIPANTS In total, interactions between 57 nursing home residents with dementia and staff from 9 different psychogeriatric wards in the Netherlands were observed. METHODS Structured observations were carried out to assess the support of resident autonomy within staff-resident interactions. Observations were performed during morning care and consisted of 4 main categories: getting up, physical care, physical appearance, and breakfast. For each morning care activity, the observers consecutively scored who initiated the care activity, how staff facilitated autonomy, how residents responded to staff, and how staff reacted to residents' responses. Each resident was observed during 3 different mornings. In addition, qualitative field notes were taken to include environment and ambience. RESULTS In total, 1770 care interactions were observed. Results show that autonomy seemed to be supported by staff in 60% of the interactions. However, missed opportunities to engage residents in choice were frequently observed. These mainly seem to occur during interactions in which staff members took over tasks and seemed insensitive to residents' needs and wishes. Differences between staff approach, working procedures, and physical environment were observed across nursing home locations. CONCLUSIONS AND IMPLICATIONS The findings of this study indicate that staff members support resident autonomy in more than one-half of the cases during care interactions. Nonetheless, improvements are needed to support resident autonomy. Staff should be encouraged to share and increase knowledge in dementia care to better address residents' individual needs. Especially for residents with severe dementia, it seems important that staff develop skills to support their autonomy.
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Stakeholder Engagement in Practice Change: Enabling Person-Centred Mealtime Experiences in Residential Care Homes. Can J Aging 2020; 40:248-262. [DOI: 10.1017/s0714980820000082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTPerson-centred care is recognized as best practice in dementia care. The purpose of this study was to evaluate the effectiveness of a stakeholder engagement practice change initiative aimed at increasing the provision of person-centred mealtimes in a residential care home (RCH). A single-group, time series design was used to assess the impact of the practice change initiative on mealtime environment across four time periods (pre-intervention, 1-month, 3-month, and 6-month follow-up). Statistically significant improvements were noted in all mealtime environment scales by 6 months, including the physical environment (z = -3.06, p = 0.013), social environment (z = -3.69, p = 0.001), relationship and person-centred scale (z = -3.51, p = 0.003), and overall environment scale (z = -3.60, p = 0.002). This practice change initiative, which focused on enhancing stakeholder engagement, provided a feasible method for increasing the practice of person-centred care during mealtimes in an RCH through the application of supportive leadership, collaborative decision making, and staff engagement.
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Lindsey Jacobs M, Lynn Snow A, Allen RS, Hartmann CW, Dautovich N, Parmelee PA. Supporting autonomy in long-term care: Lessons from nursing assistants. Geriatr Nurs 2019; 40:129-137. [DOI: 10.1016/j.gerinurse.2018.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
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4
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Simmons SF, Coelho CS, Sandler A, Shah AS, Schnelle JF. Managing Person-Centered Dementia Care in an Assisted Living Facility: Staffing and Time Considerations. THE GERONTOLOGIST 2018; 58:e251-e259. [PMID: 28575376 DOI: 10.1093/geront/gnx089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives To describe (a) the unlicensed staff time necessary to provide quality activities of daily living (ADL) care to residents receiving dementia care within an assisted living facility and (b) a staff management approach to maintain quality ADL care. Research Design and Methods Supervisory staff used a standardized observational method to measure ADL care quality and the staff time to provide care during the morning and evening across 12 consecutive months. Staff were given individual feedback about the quality of their care provision following each observation. Results The average staff time to provide ADL care averaged 35 (± 11) minutes per resident per care episode with bathing and 18 (± 6) minutes/resident/care episode without bathing. Morning ADL care required significantly more staff time than evening care. There was not a significant relationship between residents' levels of cognitive impairment or ADL dependency and the staff time to provide ADL care. Quality ADL care was maintained for 12 months. Discussion and Implications This study provides novel data related to the amount of staff time necessary to provide quality ADL care for persons with dementia in an assisted living care setting. This study also describes a standardized approach to staff management that was effective in maintaining quality ADL care provision. Assisted living facilities should consider these data when determining the necessary unlicensed staffing level to provide person-centered ADL care and how to effectively manage direct care providers.
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Affiliation(s)
- Sandra F Simmons
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
| | - Chris S Coelho
- Abe's Garden®, Alzheimer's and Memory Care Center of Excellence, Nashville, Tennessee
| | - Andrew Sandler
- Abe's Garden®, Alzheimer's and Memory Care Center of Excellence, Nashville, Tennessee
| | - Avantika S Shah
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John F Schnelle
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
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5
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Simmons SF, Coelho CS, Sandler A, Schnelle JF. A System for Managing Staff and Quality of Dementia Care in Assisted Living Facilities. J Am Geriatr Soc 2018; 66:1632-1637. [DOI: 10.1111/jgs.15463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Sandra F. Simmons
- Center for Quality Aging; Vanderbilt University Medical Center; Nashville Tennessee
- Division of Geriatrics, Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
- Geriatric Research, Education and Clinical Center; Veterans Affairs Tennessee Valley Healthcare System; Nashville Tennessee
| | - Chris S. Coelho
- Abe's Garden; Alzheimer's and Memory Care Center of Excellence; Nashville Tennessee
| | - Andrew Sandler
- Abe's Garden; Alzheimer's and Memory Care Center of Excellence; Nashville Tennessee
| | - John F. Schnelle
- Center for Quality Aging; Vanderbilt University Medical Center; Nashville Tennessee
- Division of Geriatrics, Department of Medicine; Vanderbilt University Medical Center; Nashville Tennessee
- Geriatric Research, Education and Clinical Center; Veterans Affairs Tennessee Valley Healthcare System; Nashville Tennessee
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Andrew N, Meeks S. Fulfilled preferences, perceived control, life satisfaction, and loneliness in elderly long-term care residents. Aging Ment Health 2018; 22:183-189. [PMID: 27767325 DOI: 10.1080/13607863.2016.1244804] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Person-centered care constructs such as fulfilled preferences, sense of control, and life satisfaction might contribute to loneliness among nursing home residents, but these relationships have not been thoroughly explored. The aim of this study was to examine the relationship between fulfilled preferences and loneliness in nursing home residents with perceived control and life satisfaction as potential mediators. METHODS The study utilized a cross-sectional design, examining the targeted variables with a questionnaire administered by trained research staff. A convenience sample of 65 residents (median age = 71) of eight nursing homes were interviewed. Linear regression analysis was utilized to examine the mediation hypotheses. RESULTS The relationships between fulfilled preferences and loneliness (β = -.377, p = .002), fulfilled preferences and perceived control (β = -.577, p < .001), and perceived control and loneliness (β = .606, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = -.040, p = .744) became non-significant when perceived control was included in the model. The relationships between fulfilled preferences and life satisfaction (β = .420, p < .001) and life satisfaction and loneliness (β = -.598, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = -.152, p = .174) became non-significant when life satisfaction was included in the model. CONCLUSION The findings suggest an important association between person-centered care, particularly fulfilling personal care and recreation preferences, and social-affective needs of long-term care residents. Fulfilling preferences may be an appropriate intervention target for loneliness.
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Affiliation(s)
- Nathaniel Andrew
- a Department of Psychological & Brain Sciences , University of Louisville , Louisville , KY , USA
| | - Suzanne Meeks
- a Department of Psychological & Brain Sciences , University of Louisville , Louisville , KY , USA
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Palmer JA, Parker VA, Berlowitz D, Snow AL, Hartmann CW. Resident Choice: A Nursing Home Staff Perspective on Tensions and Resolutions. Geriatr Nurs 2017; 39:271-278. [PMID: 29129450 DOI: 10.1016/j.gerinurse.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 11/28/2022]
Abstract
A central component of person-centered care, resident choice in daily life, has received little research attention in the U.S. CONTEXT This study investigated nursing home staff experiences in realizing resident choice. Twenty-six qualitative staff interviews were conducted in an opportunistic sample from two Veterans Health Administration (VHA) Community Living Centers (CLCs, i.e., nursing homes) implementing the Green House Model. Thematic content analysis surfaced several key tensions at the intra-personal, inter-personal, and organizational levels. Most salient were staff mental models within the intra-personal level. Staff conveyed a lack of clarity on how to realize resident choice when faced with varying tensions, especially the competing goal of resident medical and safety needs. Staff-employed resolutions to resident choice-related tensions also emerged (e.g., preventive practices, staff reinforcement, and staff deliberation). This study offers specific and concrete insights on how resident choice in daily life, and thus resident quality of life, can be advanced.
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Affiliation(s)
- Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, Bedford, MA 01730, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118, USA.
| | - Victoria A Parker
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118, USA.
| | - Dan Berlowitz
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, Bedford, MA 01730, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118, USA.
| | - A Lynn Snow
- Research Service, Tuscaloosa VA Medical Center (151), 3701 Loop Road East, Tuscaloosa, AL 35404, USA; Alabama Research Institute on Aging, University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, Bedford, MA 01730, USA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118, USA.
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Roberts TJ, Gilmore-Bykovskyi A, Lor M, Liebzeit D, Crnich CJ, Saliba D. Important Care and Activity Preferences in a Nationally Representative Sample of Nursing Home Residents. J Am Med Dir Assoc 2017; 19:25-32. [PMID: 28843525 DOI: 10.1016/j.jamda.2017.06.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/24/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Person-centered care (PCC), which considers nursing home resident preferences in care delivery, has been linked to important outcomes such as improved quality of life, resident satisfaction with care, and mood and reduced behavioral symptoms for residents with dementia. Delivery of PCC fundamentally relies on knowledge of resident preferences. The Minimum Data Set (MDS) 3.0 Preference Assessment Tool (PAT) is a standardized, abbreviated assessment that facilitates systematic examination of preferences from a population of nursing home residents. However, it is unknown how well the PAT discriminates preferences across residents or items. The purpose of this study was to use MDS 3.0 PAT data to describe (1) overall resident preferences, (2) variation in preferences across items, and (3) variation in preferences across residents. DATA Data from admission MDS assessments between October 1, 2011 and December 31, 2011 were used for this study. SAMPLE A nationally representative sample of 244,718 residents over the age of 65 years who were able to complete the resident interview version of preference, cognition, and depression assessments were included. MEASUREMENTS Importance ratings of 16 daily care and activity preferences were the primary outcome measures. Resident factors including function (MDS Activities of Daily Living-Long Form), depression (Patient Health Questionnaire-9), cognitive impairment (Brief Interview for Mental Status), and sociodemographics (age, race, sex, and marital status) were used as predictors of important preferences. ANALYSIS Overall preferences were examined using descriptive statistics. Proportional differences tests were used to describe variation across items. Logistic regression was used to describe variation in preferences across residents. RESULTS The majority of residents rated all 16 preferences important. However, there was variation across items and residents. Involvement of family in care and individualizing daily care and activities were rated important by the largest proportion of residents. Several resident factors including cognitive impairment, depression, sex, and race were significant predictors of preferences. CONCLUSIONS Findings demonstrate the PAT captures variation in preferences across items and residents. Residents with possible depression and cognitive impairment were less likely to rate preferences important than residents without those conditions. Non-Caucasian and male residents reported some preferences differently than Caucasian and female residents. Additional assessment and care planning may be important for these residents. More research is needed to determine the factors that influence preferences and the ways to incorporate them into care.
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Affiliation(s)
- Tonya J Roberts
- William S. Middleton Veteran Affairs Hospital, Madison, WI; University of Wisconsin-Madison, School of Nursing, Madison, WI.
| | - Andrea Gilmore-Bykovskyi
- William S. Middleton Veteran Affairs Hospital, Madison, WI; University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Maichou Lor
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Daniel Liebzeit
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | - Christopher J Crnich
- William S. Middleton Veteran Affairs Hospital, Madison, WI; University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI
| | - Debra Saliba
- VA Greater Los Angeles Healthcare System, Geriatric Research Education and Clinical Center, Los Angeles, CA; UCLA/JH Borun Center for Gerontological Research, Los Angeles, CA
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Sjögren K, Lindkvist M, Sandman PO, Zingmark K, Edvardsson D. Organisational and environmental characteristics of residential aged care units providing highly person-centred care: a cross sectional study. BMC Nurs 2017; 16:44. [PMID: 28808426 PMCID: PMC5550941 DOI: 10.1186/s12912-017-0240-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents' and staff' characteristics. METHODS A cross-sectional design was used. Residents (n = 1460) and staff (n = 1213) data from 151 residential care units were collected, as well as data relating to characteristics of the organisation and environment, and data measuring degree of person-centred care. Participating staff provided self-reported data and conducted proxy ratings on residents. Descriptive and comparative statistics, independent samples t-test, Chi2 test, Eta Squared and Phi coefficient were used to analyse data. RESULTS Highly person-centred residential aged care units were characterized by having a shared philosophy of care, a satisfactory leadership, interdisciplinary collaboration and social support from colleagues and leaders, a dementia-friendly physical environment, staff having time to spend with residents, and a smaller unit size. Residential aged care units with higher levels of person-centred care had a higher proportion of staff with continuing education in dementia care, and a higher proportion of staff receiving regular supervision, compared to units with lower levels of person-centred care. CONCLUSIONS It is important to target organisational and environmental factors, such as a shared philosophy of care, staff use of time, the physical environment, interdisciplinary support, and support from leaders and colleagues, to improve person-centred care in residential care units. Managers and leaders seeking to facilitate person-centred care in daily practice need to consider their own role in supporting, encouraging, and supervising staff.
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Affiliation(s)
- Karin Sjögren
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden
| | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden.,Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden.,Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.,Division of Caring Sciences, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Karin Zingmark
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.,Region of Norrbotten, Luleå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, SE-901 87 Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Palmer JA, Parker VA, Burgess JF, Berlowitz D, Lynn Snow A, Mitchell SL, Hartmann CW. Developing the Supporting Choice Observational Tool (SCOT): A Formative Assessment Tool to Assist Nursing Home Staff in Realizing Resident Choice. Res Gerontol Nurs 2017; 10:129-138. [PMID: 28541589 PMCID: PMC5767100 DOI: 10.3928/19404921-20170411-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/28/2017] [Indexed: 11/20/2022]
Abstract
Quality of care in nursing homes has begun to address the importance of resident choice in daily life, yet there are no published tools to teach nursing home staff how to offer such choice. In the current study, a formative assessment tool was developed that can provide staff with detailed and concrete feedback on how to realize resident choice. The tool was created and refined through 22 hours of ethnographic observation in two Veterans Health Administration Community Living Centers (CLCs), 22 hours of developmental testing in two CLCs, review by a modified Delphi panel, and use of an algorithm to assess its logical structure. The resulting Supporting Choice Observational Tool (SCOT) documents how choice is or is not offered and is or is not enabled within a singular staff-resident interaction. SCOT findings could be used in clinical teaching, quality improvement, or research efforts intent on enhancing nursing home resident quality of life. [Res Gerontol Nurs. 2017; 10(3):129-138.].
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11
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Garcia TJ, Harrison TC, Goodwin JS. Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions. QUALITATIVE HEALTH RESEARCH 2016; 26:712-28. [PMID: 25721717 PMCID: PMC5371402 DOI: 10.1177/1049732315573206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged.
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Affiliation(s)
| | | | - James S Goodwin
- The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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12
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Chaudhury H, Hung L, Rust T, Wu S. Do physical environmental changes make a difference? Supporting person-centered care at mealtimes in nursing homes. DEMENTIA 2016; 16:878-896. [DOI: 10.1177/1471301215622839] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Drawing on therapeutic physical environmental design principles and Kitwood’s theoretical view of person-centered care, this study examined the impact of environmental renovations in dining spaces of a long-term care facility on residents’ mealtime experience and staff practice in two care units. Method The research design involved pre- and post-renovation ethnographic observations in the dining spaces of the care units and a post-renovation staff survey. The objective physical environmental features pre- and post-renovations were assessed with a newly developed tool titled Dining Environment Audit Protocol. We collected observational data from 10 residents and survey responses from 17 care aides and nurses. Findings Based on a systematic analysis of observational data and staff survey responses, five themes were identified: (a) autonomy and personal control, (b) comfort of homelike environment, (c) conducive to social interaction, (d) increased personal support, and (e) effective teamwork. Implications Although the physical environment can play an influential role in enhancing the dining experience of residents, the variability in staff practices reveals the complexity of mealtime environment and points to the necessity of a systemic approach to foster meaningful culture change.
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Affiliation(s)
| | | | - Tiana Rust
- University of Alberta, Edmonton, AB, Canada
| | - Sarah Wu
- Simon Fraser University, Vancouver, BC, Canada
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13
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Fain KM, Rosenberg PB, Pirard S, Bogunovic O, Spira AP. Markers of Impaired Decision Making in Nursing Home Residents: Assessment by Nursing Home Staff in a Population-Based Study. J Am Med Dir Assoc 2015; 16:563-7. [DOI: 10.1016/j.jamda.2015.01.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/05/2014] [Accepted: 01/07/2015] [Indexed: 11/27/2022]
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14
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Simmons SF, Rahman AN. Next Steps for Achieving Person-Centered Care in Nursing Homes. J Am Med Dir Assoc 2014; 15:615-9. [DOI: 10.1016/j.jamda.2014.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
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15
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Quality assurance and performance improvement in nursing homes: using evidence-based protocols to observe nursing care processes in real time. J Nurs Care Qual 2013; 28:43-51. [PMID: 22902936 DOI: 10.1097/ncq.0b013e31826b090b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Quality Assurance and Performance Improvement Initiative, a component of the Affordable Care Act (2010), is a new approach to quality improvement for US nursing homes. The article describes components of the Quality Assurance and Performance Improvement Initiative, the unique contributions of registered nurses to its implementation, and data collection strategies using direct observation and evidence-based measures and protocols in a Quality Assurance and Performance Improvement program.
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Schnelle JF, Rahman A, Durkin DW, Beuscher L, Choi L, Simmons SF. A controlled trial of an intervention to increase resident choice in long term care. J Am Med Dir Assoc 2013; 14:345-51. [PMID: 23294967 DOI: 10.1016/j.jamda.2012.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/28/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care. DESIGN A controlled trial with a delayed intervention design. SETTING Four community, for-profit nursing homes. PARTICIPANTS A total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences. INTERVENTION Research staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff. MEASUREMENTS Research staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention. RESULTS There was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001). CONCLUSION A staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care.
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Affiliation(s)
- John F Schnelle
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN, USA.
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17
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Abstract
There continue to be serious deficiencies in the quality of life available to many nursing home residents in the United States. One significant response to this undesirable situation is the nursing home "Culture Change" movement, which attempts to improve the nursing home environment-and consequently residents' quality of life-by making facilities less institutional and more homelike. One of the impediments often interfering with the adoption and implementation of culture change in specific facilities is apprehension by staff, administrators, and governing boards about potential legal liability and regulatory exposure if residents suffer injuries that might arguably be attributed to facility conditions or policies that were inspired and encouraged by the culture change movement. This article addresses and responds to the provider liability and regulatory apprehensions that impede the progress of culture change in nursing homes, using proposed new dietary services standards as an example.
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Affiliation(s)
- Marshall B Kapp
- *Address correspondence to Marshall B. Kapp, JD, Center for Innovative Collaboration in Medicine and Law, Florida State University, 1115W. Call Street, Tallahassee, FL 32306-4300. E-mail:
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18
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Simmons SF, Durkin DW, Rahman AN, Schnelle JF, Beuscher LM. The value of resident choice during daily care: do staff and families differ? J Appl Gerontol 2012; 33:655-71. [PMID: 25143465 DOI: 10.1177/0733464812454010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Allowing long-term care (LTC) residents to make choices about their daily life activities is a central tenet of resident-centered care. This study examined whether staff and family rated care episodes involving choice differently from care episodes not involving choice. Seventeen nurse aide and 15 family participants were shown paired video vignettes of care interactions. Participants were asked to rate their preferred care vignette using a standardized forced-choice questionnaire. Focus groups were held separately for staff and family members following this rating task to determine reasons for their preferences. Both staff and family rated the vignettes depicting choice as "strongly" preferred to the vignettes without choice. Reasons provided for the preference ratings during the focus group discussions related to resident well-being, sense of control, and respondents' own personal values. These findings have implications for LTC staff training related to resident-centered care to promote choice.
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Affiliation(s)
- Sandra F Simmons
- Vanderbilt University, Nashville, TN, USA VA Medical Center, Geriatric Research, Education and Clinical Center, Nashville, TN, USA
| | | | | | - John F Schnelle
- Vanderbilt University, Nashville, TN, USA VA Medical Center, Geriatric Research, Education and Clinical Center, Nashville, TN, USA
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Simmons SF, Durkin DW, Rahman AN, Choi L, Beuscher L, Schnelle JF. Resident characteristics related to the lack of morning care provision in long-term care. THE GERONTOLOGIST 2012; 53:151-61. [PMID: 22565494 DOI: 10.1093/geront/gns065] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The purpose of this study was to examine usual long-term care (LTC) practices related to 3 aspects of morning care and determine if there were resident characteristics related to the lack of care. DESIGN AND METHODS Participants were 169 long-stay residents in 4 community LTC facilities who required staff assistance with either transfer out of bed, dressing, and/or incontinence care and were able to respond to structured interview questions about their morning care preferences. Trained research staff conducted standardized observations during 4 consecutive morning hours once per week per participant for 3 consecutive months during usual LTC conditions and interviewed participants about their morning care preferences using a structured interview protocol once per month during this same time period. RESULTS Overall, 40% of the observations showed a lack of morning care provision, including any staff-resident communication about care, during the 4-hr observation period. Participants rated by staff as more physically dependent and requiring 2 staff for transfer were more likely to not receive morning care. Even when care in a particular area was absent, the majority of participants expressed a stable preference for care to remain the "same" (range of proportions was .75 to .87 for the 3 targeted care areas) and infrequently made requests for care. IMPLICATIONS Efforts to promote resident-directed care should consider staffing issues related to missed care occurrences and resident issues related to level of dependency on staff as well as reduced expectations for care, which can lead to resident acceptance of low care frequencies.
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Affiliation(s)
- Sandra F Simmons
- Division of General Internal Medicine and Public Health, School of Medicine, Vanderbilt University, Center for Quality Aging, Nashville, TN, USA.
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Simmons SF, Rahman A, Beuscher L, Jani V, Durkin DW, Schnelle JF. Resident-directed long-term care: staff provision of choice during morning care. THE GERONTOLOGIST 2011; 51:867-75. [PMID: 21719629 DOI: 10.1093/geront/gnr066] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To develop an observational protocol to assess the quality of staff-resident communication relevant to choice and describe staff-resident interactions as preliminary evidence of the usefulness of the tool to assess current nursing home practices related to offering choice during morning care provision. DESIGN AND METHODS This study included 73 long-stay residents in 2 facilities. Research staff conducted observations for 4 consecutive morning hours during targeted care activities (transfer out of bed, incontinence, dressing, and dining location). Observations were conducted weekly for 12 consecutive weeks. Staff-resident interactions were measured related to staff offers of choice and residents' responses. RESULTS Interrater agreement was achieved for measures of staff offers of choice (kappa = .83, p < .001), type of choice provided (kappa = .75, p < .001), and resident requests related to choice (kappa = .72, p < .001). Observations over 2,766 care episodes during 4 aspects of morning care showed that staff offered residents choice during 18% of the episodes. Most observations (70%) were coded as staff offering "no choice." IMPLICATIONS Nursing home staff can use a simplified version of this standardized observational tool to reliably measure staff-resident interactions related to choice during morning care provision as a first step toward improving resident-directed care practice.
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Affiliation(s)
- Sandra F Simmons
- Division of General Internal Medicine and Public Health, Center for Quality Aging, School of Medicine, Vanderbilt University Medical Center, S-1121, Nashville, TN 37232-2400, USA.
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Need support and wellbeing during morning care activities: an observational study on resident–staff interaction in nursing homes. AGEING & SOCIETY 2011. [DOI: 10.1017/s0144686x10001522] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTQuality of life and wellbeing in nursing homes are becoming more important in research and practice. One of the main influences on residents' wellbeing is the interaction with their professional care-givers. The purpose of this study was to explore to what extent care-givers support the residents' needs of relatedness, autonomy and competence, and how this need support is related to wellbeing. Residents and their professional care-givers of four nursing homes in the Netherlands participated in an observational and questionnaire study. Three video-observations of each resident (with different care-givers) were made during morning care. Additional data were collected by means of questionnaires. The results show that the needs of residents were, on average, moderately fulfilled during care interactions. More need support by care-givers was related to higher resident wellbeing. Care-givers provided more need support to residents with stronger functional impairments. More need support was provided by higher-educated care-givers and care-givers in higher job functions. The results show the importance of need support for situational wellbeing, but the contribution to the general subjective wellbeing of residents remains unclear. Further (longitudinal) research is needed to investigate changes in wellbeing over time. Possible differences between subjective ratings and observations of need support and wellbeing should be taken into account.
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Abstract
Concerns about the quality of long-term care have resulted in an extensive array of regulations governing provider behavior. This article reports the results of a survey of 1,147 long-term care specialists on issues related to the government’s performance in assuring quality and improving care. With the exception of providers, more than half of specialists ranked the quality of the average nursing home as fair or poor; home health agencies and even assisted-living facilities fared only somewhat better. Yet despite the perceived ineffectiveness of the current regime, the majority of specialists expressed a general willingness to continue pursuing more stringent and enhanced enforcement and to proceed down the same path with assisted-living facilities. Furthermore, while most were not sanguine about public reporting, the majority favored pay-for-performance, even though both rely on the same information. In addition to constituency group affiliation, differences in views derived largely from respondents’ ideological predispositions.
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